血液标本放置时间和抗凝剂对血糖检测结果的影响

目的 :探讨两种抗凝剂的血液标本放置时间对血糖测定的影响。方法 :采集门诊健康人血液标本 30份 ,分别以肝素钠和氟化钠作抗凝 ,放置不同时间检测血糖值。结果 :及时分离血浆的血液标本血糖在 5h内差异无显著性。而血液离体后不及时分离血浆 ,血糖是随着时间延长而降低。氟化钠抗凝的血糖比肝素钠抗凝的血糖下降的程度要缓慢一些 ,所以临床上采集血液标本必须及时分离血浆 ,选用合适的抗凝剂 ,及时测定 ,减少误差 ,提高准确性 ,给临床提供准确的诊断依据     

Subakute Verlegung der Atemwege infolge eines retropharyngealen H?matoms nach Halstrauma

Mechanical airway obstruction secondary to retropharyngeal bleeding is rare. In most cases such a complication is described after head and neck trauma. Complicating factors include anticoagulant therapy, tumour, aneurysm, infection or major cervical spine injury. A precise initial diagnosis is necessary to avoid a life-threatening situation. Lateral X-ray and computed tomography is essential for safe management. Treatment depends upon size of the haematoma as well as the clinical course of the patient. Smaller haematomas may be observed. Lager haematomas and those that fail to reabsorb should undergo drainage.      

Successful embolization of a large superior gluteal artery pseudoaneurysm emerging during anticoagulant therapy

Gross hemorrhage is the most serious complication of anticoagulant therapy. We report the discovery and treatment of a large pseudoaneurysm of the superior gluteal artery in one patient who had been receiving oral anticoagulant therapy. We diagnosed the pseudoaneurysm by contrast-enhanced computed tomography, and embolized the artery with stainless steel coils. The exact cause of the pseudoaneurysm remains unclear, however, minor trauma appears most likely.     

心脏机械瓣膜置换术后分娩的临床研究

目的 探讨心脏机械瓣膜置换术后分娩的临床处理措施。方法 对19例心脏机械瓣膜置换手术后妊娠及分娩的资料进行回顾性分忻。结果 19例心脏机械瓣膜置换术后产妇均安全度过孕产期。分娩前后心功能Ⅰ～Ⅲ级，分娩时出血200～260m1，胎儿体重2950--3146g。无母婴死亡者，无胎儿出血以及畸形者。结论 心脏机械瓣膜置换术后心功能Ⅰ～Ⅲ级可安全度过孕产期。分娩采用剖宫产术为宜。妊娠期间口服抗凝剂(华法林)不增加分娩时母婴出血和新生儿畸形。     

Anticoagulation after valve replacement: a multicenter retrospective study

Anticoagulant therapy after cardiac valve replacement was evaluated retrospectively in 1,200 patients attending 8 cardiac surgery clinics in the Tokyo area as part of the Tokyo Area Study on Anticoagulation After Cardiac Valve Replacement Using PT-INR (TAS). A prospective trial is also in progress and will be reported later. The prothrombin time international normalized ratio (PT-INR) was determined at the time of thromboembolic and bleeding complications in 1,200 patients. During the 5 year study period, thromboembolisms occurred in 21 patients, and bleeding complications occurred in 15 patients. In 71% of patients with thromboembolism and 47% of those with bleeding complications, the PT-INR was within the range of 1.6 to 2.8, which is the accepted therapeutic range in Japan. Therefore, the correct PT-INR therapeutic range for Japanese patients with mechanical heart valves needs to be reexamined, and data from the prospective TAS trial that is currently underway will be used for this purpose.     

Synthesis of 4-hydroxy-1-thiocoumarin derivatives-1: An efficient synthesis of thioflocoumafen

An efficient procedure for the preparation of 4-hydroxy-3-{1,2,3,4-tetra-hydro-3-[4-(4-triflu-oromethylbenzyl oxy)phenyl]-1-naphthyl}thiocoumarin (thioflocoumafen, 1a and 1b) is described. The key step in the synthesis involves the condensation reaction of 3-(4-methoxyphenyl)-1-tetralol (2) with 4-hydroxy-1-thiocoumarin (3).     

广州市家栖鼠对第一代抗凝血灭鼠剂抗药性研究

目的探讨家栖鼠对抗凝血灭鼠剂的抗药性变化。方法按全国鼠类抗药性监测协作组统一方法,进行无选择性摄毒试验。结果经对广州市所辖9区内捕获的130只褐家鼠、31只黄胸鼠、18只小家鼠进行抗药性监测,其抗性率分别为8.5%、45.2%和27.8%,总平均摄药剂量分别为17.72、278.46和1164.24mg/kg,按家栖鼠抗药性检验标准,黄胸鼠和小家鼠对第一代抗凝血剂杀鼠灵已形成抗药性种群,褐家鼠有抗药性个体产生。结论以黄胸鼠和小家鼠为优势种的场所,要考虑使用第二代抗凝血灭鼠剂;以褐家鼠为主的场所,则可继续使用第一代抗凝血灭鼠剂,但应加强对灭鼠药物的敏感性监测,科学、合理用药。     

家栖鼠对抗凝血灭鼠剂抗药性研究与应用前景分析

目的探讨湛江地区应用抗凝血灭鼠剂以来,家栖鼠抗药性发生情况以及演变规律,为灭鼠用药提供科学依据.方法于不同时期、不同地区捕捉黄胸鼠和褐家鼠,按全国鼠类抗药性协作组统一方法进行抗药性试验.结果使用第一代抗凝血灭鼠剂10年,黄胸鼠由敏感种群逐步产生抗药性个体,当使用到17年,湛江市区黄胸鼠便形成抗药性种群,但改用第二代抗凝血剂溴敌隆能缓解前者的抗药性;同一时期各地区使用抗凝血灭鼠剂频度及使用方法对黄胸鼠抗药性有所影响;褐家鼠抗药性一直维持在较低水平;黄胸鼠和褐家鼠之间抗药性发生率差异有统计学意义（χ^2=41.676,P＜0.01）.结论使用抗凝血灭鼠剂要遵循鼠类抗药性的产生和发展规律,开展定期抗药性监测,科学选用第一代或第二代抗凝血灭鼠剂,才能确保灭鼠效果及延长抗凝血灭鼠剂的应用时间.     

神经节苷脂对早产儿脑白质损伤的临床疗效观察与分析

目的探讨神经节苷脂(GM1)在早产儿脑白质损伤治疗中的临床意义。 方法对入住北京大学第一医院新生儿ICU病房的早产儿于生后1周内常规行床旁头颅B超检查，将确诊为脑白质损伤(WMD)的89例患儿分为GM1治疗组及对照组。在积极治疗早产儿各项并发症的基础上，治疗组另给予GM1治疗，动态观察头颅B超的变化情况并进行随访。 结果在收治的356例早产儿中，确诊WMD的患儿89例，发生率为25%。第一疗程GM 1治疗后，经头颅B超的动态观察，治疗组的56例均较对照组好转，差异有显著性(P<0.05)。治疗组中有33例患儿追踪至生后6个月，头颅超声显示16例出现了脑室扩大，占48%；2例出现了明显的智力及运动发育落后，约占6%；5例表现为限局性的肌张力、运动异常及轻微的认知障碍，占15%。对照组中有10例患儿追踪至生后6个月，8例出现脑室扩大，占80%；3例出现了明显的智力及运动发育落后，占30%；2例出现了轻微的认知及行为障碍，占20%。 结论GM 1可减少脑白质软化及持续性病变的发生，改善预后。